The glory of traction

Ah – intermittent spinal traction – what a technique. Traction is not the done thing these days due to a number of guideline reccomendations. This may be a pity.

I have fond memories of traction though – It was great – You could put a patient on traction and go and have a smoke or see another patient at the same time. Many therapists have gone out for lunch and come back and realised they still had a patient on traction (“We won’t be charging you for long consult!). My traction techniques have pulled a man’s pants down and in another case a bad reaction followed – my patient had been held by his ankles over the side of a building site. If only I was more biopsychosocial in the old days, traction may not have been the treatment selection.

James Cyriax of course was a great tractioner. I can still see an X-Ray image in his book of a lumbar spine before and during traction – wow – traction seemed to let a lot of air in and give everything space. If anyone has the image I would love you to post it. Traction machines come in all shapes, sizes and complexity and still do. The simple one drawn in Geoff Maitland’s books was two pieces of wood rolling on wooden dowels. Geoff tried to sell it to me once for 50 bucks but I declined and a famous piece of physiotherapy equipment went to the dump.

But I am pleased that there is research suggesting that there may be subgroups of patients who may benefit from lumbar traction (Fritz, J. et al 2007 Spine 32:E793). One group had suggestions of nerve root compression, and presented with leg symptoms and crossed straight leg raise. Have you ever thought what a powerful word it is too – “I am going to give you some traction” has a ring about it.
We would love your traction stories and discussion.

David Butler

9 Responses to “The glory of traction”

  1. Raúl Martínez Torres (@RMartinezTorres)

    In my opinion, if the traction is done manually by a physiotherapist and the physiotherapist controls all kind of possible symptons reactions, it is a great technique and a very different technique from that one where you connect a patient to a machine to be tractioned

    Reply
  2. davidbutler0noi

    I am sure there is some power in the term “I am going to give you some traction” – Perhaps better than “I am going to give you some compression! ”

    I don’t think we should throw all the old tools out, but as Raúl suggests, it is surely more then just leaving someone tied up and tractioned for a time.

    One variant on traction that I used frequently for nerve root problems was to do neural mobilisation exercises while they were on traction – ie one technique may be to have the patient on traction with a small stool under their knees so they are in some hip flexion and knees at 90 degrees. Then during the traction phase, get them to extend their knee(s). It just kind of made sense from a pathoanatomical base and of course it brought in a bit of self managment and knowledge.

    David

    Reply
    • Rob Neish

      Thanks for bringing up such a wonderful topic.

      I loved my traction table! I could never work out why others did not use it. I didn’t use it for everyone, just those that fitted the right presentation.

      I recall literature guidelines along the lines of a maximum tension of around 5 kg for necks and 20 kg for backs. Through some educated trial and error and noticing when symptoms improved – it seemed that necks did well with around 5-12 kg and occasionally 20kg was needed to reduce symptoms. Backs were usually 30-40 kg. So possibly a reason for traction’s lack of effectiveness might have been related to ineffective poundages.

      On one memorable occasion 75kg was needed to remove severe acute back pain in a 25 year old carried in by his workmates. He was pain free at that level and about one third of his pain returned after treatment. He was fine 2 days later.

      I also remember that some traction tables came with pelvic belts that couldn’t hold the tension if they weren’t able to double back on themselves before Velcro fastening. So these tables couldn’t actually deliver a strong enough stretch to be effective.

      Generally if a patient said they couldn’t feel anything happening, then nothing was happening. I don’t think I was imagining things but it was possible to palpate the vertebral spinous processes and feel the separation.

      A final unintended consequence was a client who was a fan of traction telling me that after a few goes he’d noticed that his irritable bowel symptoms had markedly improved – presumably some bowel adhesions had been dealt to.

      Rob Neish

      Reply
  3. Just one word | NOI Notes

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    Reply
  4. pcgarciasanchez

    Reblogged this on Edu_OMT and commented:
    Lovely memories: remembering school clinical placement practices 15 years ago and Jenny Roberts update in the IMPX.
    I usually found myself saying quietly that I do traction too, trying not to be heard by my peers…
    I agree, maybe we are not choosing the accurate patients for this technique, or the accurate moment trough the patient clinical evolution.
    But definitively: some patients love cervical manual traction, usually in an intermittent way.

    Reply
  5. pcgarciasanchez

    Lovely memories: remembering school clinical placement practices 15 years ago and Jenny Roberts update in the ICPY.
    I usually found myself saying quietly that I do traction too, trying not to be heard by my peers…
    I agree, maybe we are not choosing the accurate patients for this technique, or the accurate moment trough the patient clinical evolution.
    But definitively: some patients love cervical manual traction, usually in an intermittent way.

    Reply
  6. davidboltononoi

    I wonder what ever became off her……..remember those old traction machines with the big wheel at the end of the bed that you used to spin to apply the poundage. Equally those old corsets- before velcro- with the buckles and tiger teeth that pieced through the material to close them !!!! Imagine the poor lady “Strapped in ” and some idiot had forgotten to zero the wheel before pressing the start switch!!!! Every tried to undo buckles and clips under increasing poundage????

    Reply
  7. Helen Beeley

    I remember an unfortunate encounter when learning cervical traction as a student in the early 90’s. It was the type of traction unit that involved hanging weights. I was lying down, with the harness attached to the wall and all was going well. However my fellow student decided the bed looked a bit ‘crooked’ and she grabbed the foot of the bed and pulled – obviously forgetting that my head was attached to the wall. While being rather painful, the main thing I remember is going deaf for about 30 minutes.

    Reply

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